| NPI | 1497741789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NE 439) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NE 439) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NE 439) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NE 439) | |
| 103TC0700X Psychologist, Clinical (Licence: NE 439) | |
| 103TC1900X Psychologist, Counseling (Licence: NE 439) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NE 439) | |
| 103TF0000X Psychologist, Family (Licence: NE 439) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NE 439) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2014-01-08 |